Health quality measures systems and methods

ABSTRACT

Systems and methods of exchanging Healthcare Quality Measures (HQM) are disclosed. Healthcare providers can define one or more HQMs by constructing expressions using an expression builder according to a funding organization&#39;s requirements. The expression builder advantageously allows the Healthcare provider to build measure expressions without the need to know a complex programming language. Once a measure is derived, it can be converted to a common HQM data format and exchanged with the organization via an intermediary HQM service. The HQM data can then be converted into the organization&#39;s proprietary format. Thus, HQM data exchanges among providers and organizations are simplified.

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/721,043, filed on Mar. 10, 2010 which is a non-provisionalof U.S. Provisional Application No. 61/159,327, filed on Mar. 11, 2009.

FIELD OF THE INVENTION

The field of the invention is healthcare data flow and management.

BACKGROUND

Health organizations require healthcare providers to submit measures ofthe provider's performance for various reasons. One reason includestracking provider performance measures over time to ensure quality careis provided. Another reason includes ensuring that providers meet anyrequirements to receive funds (e.g., grants, reimbursement, incentives,etc). Regardless of the reasons, the known reporting systems aredifficult to use and are highly inefficient.

Others have put forth effort toward coordinating communications amonghealthcare entities. For example, the following reference describevarious aspects of healthcare quality management:

U.S. patent application publication to Wang titled “Systems and Methodfor Real Time Regional Feedback”, filed Jan. 30, 2006, describes asystem that provides for monitoring of healthcare quality measuresacross organization boundaries. The contemplated system allowsorganizations to align themselves with the industry's leadingperformers.

This and all other extrinsic materials discussed herein are incorporatedby reference in their entirety. Where a definition or use of a term inan incorporated reference is inconsistent or contrary to the definitionof that term provided herein, the definition of that term providedherein applies and the definition of that term in the reference does notapply.

U.S. patent application publication to Faris et al. titled“Evidence-Based Quality Improvement and Risk Management SolutionsMethod”, filed Jun. 14, 2005, describes a tool selection system thatselects tools to improve quality based on evidence from literature. Theselection process can include determining national authoritativehealthcare quality measures.

U.S. patent application publication to Moore titled “Management ofHealth Care Data”, filed Feb. 1, 2006, provides for systems and methodsof syndicating healthcare data among collaborators.

U.S. patent application publication to Wennberg titled “Systems andMethods for Analysis of Healthcare Provider Performance”, filed Oct. 3,2006, discusses using healthcare measures, both expected and actual, todetermine if some services are unwarranted.

U.S. patent application publication to Friedlander et al. titled “Systemand Method for Quality Control in Healthcare Settings to ContinuouslyMonitor Outcomes and Undesirable Outcomes such as Infections,Re-Operations, Excess Mortality, and Readmissions”, filed Apr. 27, 2007,describes a probability analysis system that can be used within ahealthcare quality measure environment.

U.S. patent application publication to Baker et al. titled “Rules-BasedSoftware and Methods for Health Care Measurement Applications and UsesThereof”, filed Dec. 7, 2007, describes a system that convertshealthcare data into healthcare measures.

One problem with existing systems is that they fail to account for theexpansive number of reporting channels among providers and/ororganizations. A provider could engage with five, ten, twenty, or moreorganizations, while an organization could literally interface withhundreds of providers. The sheer number of engagements and communicationchannels is overwhelming in such a many-to-many environment. It's nowonder such communication exchanges are prone to data errors.

The issues surrounding many-to-many communication exchanges in themedical field are exacerbated by the myriad of data formats that arerequired for reporting healthcare quality measures (e.g., metrics). Aprovider is required to report measures according to five, ten or moredifferent data formats as required by various organizations. This placesan undue burden on the providers, especially smaller providers, privatepractices for example. Of course the reverse is true as well. Anorganization engages with many different providers where each providerprefers to utilize their own reporting formats.

Another problem is that each organization has proprietary requirementsfor establishing a measure (e.g., a metric) of performance. A providercould easily be required to submit hundreds, if not thousands ofdifferent measures across multiple organizations, where each measure hasa complex set of requirements. Providers must spend considerable amountsof time to ensure they are reporting a proper measure to the correctorganization.

Yet another problem associated with existing Healthcare Quality Measure(HQM) reporting solutions is that the solutions require a provider tohave access to highly skilled computer labor to compile, analyze, andproduce measure reports. Known systems require a provider to install andmanage highly complex databases, query the databases using arcane SQLstatements, and compile reports according to the various formatsdiscussed above. The skills required for such work are often beyond thecapability of a provider or beyond a provider's budget for hiringskilled labor. Unfortunately, most providers simply cannot providereports, thereby reducing their chances of obtaining funding, grants,incentives, or other benefits.

The above issues combine to create additional problems, even for thoseproviders that do have access to the necessary skilled labor. Thevoluminous number of measures coupled with reporting requirementsresults in the provider lacking sufficient time (1) to compile relevantencounter data from their databases of patient and encounter data, (2)to analyze the compiled data to derive measures, and (3) to provide theresults to the various organizations according to preferred formats.Most providers simply lack time or resources to report to all desirableorganizations in a timely fashion.

Thus there is a still considerable need systems, configurations, ormethods for providing healthcare quality measure (HQM) reports thataddresses the above issues.

SUMMARY OF THE INVENTION AND EMBODIMENTS

The present inventive subject matter is drawn to systems,configurations, and methods of providing HQM reports from healthcareproviders to healthcare organizations. In a preferred embodiment, theissues surrounding the many-to-many communication exchanges can bealleviated through the use of an intermediary HQM service. The HQMservice preferably offers capabilities to convert or translate aprovider's patient and encounter data from a proprietary format to acommon HQM format. Furthermore, HQM service also allows a provider todefine one or more measures easily that conforms to the requirements ofremote healthcare organizations. Preferred HQM services also providereporting modules configured to submit reports having proper measures tothe various organizations. The contemplated HQM service streamlines themeasure reporting process to ensure that providers submit correctmeasures in the correct format to the proper organizations in a timelyfashion.

Healthcare providers represent entities that aid individuals with theirhealth related needs. Providers can be an individual person, a business,an organization, or other entity. Example providers include doctors,nurses, private practices, clinics, hospitals, aid organizations (e.g.,Doctors without Boarders), etc.

Healthcare organizations represent entities that monitor or fundproviders. The term “organization” is used euphemistically, and shouldbe considered to include any group (e.g., a business, organization,foundation, person, etc.). Example healthcare organizations includecity, state, or federal governments, foundations, grantingorganizations, universities, or other organizations that likely act in afunding or sponsor capacity.

As used herein, a “measure” represents a metric of performance for aprovider. In some embodiments, a measure is a ratio of a number(numerator) of patient encounters satisfying selection criteriaassociated with a type of care, to the number (denominator) of a baseset of patient encounters. A preferred measure also comprises one ormore lists of entries representing encounters, where the lists cancorrespond to the various selection criteria. Providing the contemplatedlists, preferably through the HQM service and its associated HQManalysis modules, allow organizations to drill down into the measuredata as opposed to merely receiving a number.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a schematic overview of a contemplated HQM system.

FIG. 2 is a schematic of a healthcare provider client interface to anHQM service.

FIG. 3 is a schematic of an HQM service capable of operating as ananalysis engine.

FIG. 4 is a schematic of a healthcare organization client interface toan HQM service.

FIG. 5 is a schematic of a method of transforming health qualitymeasurement data.

FIG. 6 is an interface for building a measure.

FIG. 7 is an interface for converting and displaying a measureexpression as SQL queries.

FIG. 8 is an interface for converting and displaying a measureexpression in postfix notation.

FIG. 9 is an interface for displaying patient counts and lists.

DETAILED DESCRIPTION

It should be noted that while the following description is drawn to acomputer/server based work package processing system, variousalternative configurations are also deemed suitable and may employvarious computing devices including servers, interfaces, systems,databases, agents, peers, engines, controllers, portals, platforms,modules, or other types of computing devices operating individually orcollectively. One should appreciate the computing devices comprise aprocessor configured to execute software instructions stored on atangible, non-transitory computer readable storage medium (e.g., harddrive, solid state drive, RAM, flash, ROM, etc.). The softwareinstructions preferably configure the computing device to provide theroles, responsibilities, or other functionality as discussed below withrespect to the disclosed apparatus. In especially preferred embodiments,the various servers, systems, databases, or interfaces exchange datausing standardized protocols or algorithms, possibly based on HTTP,HTTPS, AES, public-private key exchanges, web service APIs, knownfinancial transaction protocols, or other electronic informationexchanging methods. Data exchanges preferably are conducted over apacket-switched network, the Internet, LAN, WAN, VPN, or other type ofpacket switched network. One should also appreciate that the disclosedtechniques increase an efficiency of communicating healthcare data amonga distributed set of healthcare entities (e.g., providers,organizations, services, etc.).

FIG. 1 provides a schematic overview of a contemplated HQM system 100.Multiple, unrelated healthcare providers 110 exchange HQM data 130 withmultiple, unrelated health organizations 120 via an intermediary HQMservice 150. The HQM service 150 provides for normalizing the variousdata formats, measure requirements, or reporting requirements among theparticipants in the HQM community. Communications, reporting, or otherdata exchanges preferably occur over a packet switched network 115(e.g., the Internet, LAN, WAN, WLAN, etc.). The HQM service 150essentially eliminates most of the many-to-many communication exchangeissues by flattening the communication space among the variousparticipants. By reducing the hurdles for reporting measures to fundingsponsors 120 or other organizations 120, providers 110 are able toquickly and efficiently receive funding or incentives from theorganizations.

Patient or encounter data can be stored in one or more databases. Anysuitable database can be used as desired. Example databases includeAccess, MySQL, PostgreSQL, or other commercially available database. Asused herein “database” should be construed to mean a computing deviceconfigured to store and retrieve data from a storage device (e.g., HDD,SSD, CD, DVD, NAS, SAN, RAID system, etc.).

Although FIG. 1 illustrates an embodiment where an HQM service 150 isaccessed by the participants of the HQM community over the Internet, itis specifically contemplated that the various combinations features,capabilities, interfaces, modules, or other elements of the service canbe implemented local to each site. For example, many of the analysisaspects of the service 150 could be installed local to a provider site110.

FIG. 2 presents an overview of a healthcare provider site 210 where aprovider utilizes a provider HQM interface 260 to access one or morecapabilities of the HQM system, assuming proper authentication. As usedherein the term “interface” should be considered a computing device orcomputing component configured to execute software instruction stored oncomputer readable media. The HQM interface 260 is configured to allow aprovider to enter or to receive HQM related data 230 from the HQMsystem. Example provider HQM interfaces 260 include computers with webbrowsers, web services application program interfaces (API), networkinterfaces, or other similar interfaces that are configured to presentHQM information.

Preferably provider interface 260 includes the capability of receivingan organization's measure requirements 262, possibly from the HQMservice 250. The service 250 can exchange measure requirements 262 amongthe various participants via a common HQM format to reduce risk ofprovider confusion. This ensures that the provider 210 can easilyleverage their experience working on measures from a first organizationto those of a second organization, without having to learn new measureformats or requirements. The provider 210 can use the interface 260 toaccess a measure builder 264 that allows provider 210 to define ameasure 266 that pertains to the provider's patient data 280, regardlessof the proprietary format of the data 280. Once defined, the measure 266can be derived.

One acceptable measure builder 264 can include NextGen™ ExpressionEvaluator. A preferred measure builder 264 reduces a requirement that aprovider needs highly skilled technical labor by offering the provider210 several enhanced capabilities. For example, the measure builder 264can utilize a data format normalizer 270 (e.g., a translator) that canautomatically convert encounter data 280 from a provider's data formatto the common HQM format. Another capability allows the provider todrag-and-drop, or to point-and-click in order to modify elements of ameasure expression to build a measure 266, without requiring theprovider 210 to draft complex SQL queries. The expression elements caninclude parameters, constants, lists of encounter entries to beprocessed or analyzed, operators, or other expression elements.

In some embodiments, the HQM service 250 communicates with a HQM agent268 that is configured to exchange data 230 with the remote HQM service250 and with the provider 210 via the provider interface 260. The agent268 can receive provider-defined measures 266 and possibly derive theactual measures from the patient data 280. Once the measure informationis collected from the patient data 280, the agent can normalize the datainto a common HQM data format (e.g., serialized measure data 272) viathe data format normalizer 270. The measure information can beserialized, possibly using XML or other serializing format, and sentback as data 230 over a network 215 to the HQM service 250.

One should appreciate that the provider HQM interface 260 can beembodied by a computer system having one or more HQM client softwaremodules 290 installed. Alternatively, the computer system could includea web browser that accesses the provider interface capabilities from anHTTP server, either locally resident at the provider site 210 or remotefrom the provider site 210.

FIG. 3 illustrates a possible embodiment of an HQM service 350implemented as a web service accessible over a network 315. In apreferred embodiment, an HQM service 350 comprises an HQM analysisengine 350 capable of processing various measures from providers 310 asrequired by various organizations 320. The HQM analysis engine 350 caninclude a network interface 351, possibly an HTTP server, configured tocommunicate to remote participants in the HQM community includingproviders 310 or organizations 320. For example, the analysis engine 350can utilize an agent interface 352 through which it can exchange data330 with provider HQM agents (e.g., commands, serialized HQM data,queries, etc.), or other aspect of a provider HQM client. Additionally,the engine 350 can employ an organization interface 353 through whichthe engine 350 can exchange measure requirements, reports, or other HQMrelated information with remote organization HQM clients 320.

As used herein, the term “engine” should be considered a computingdevice configured to execute software instructions stored on a computerreadable medium. Preferably the software instructions include HQManalysis capabilities for deriving measures from normalized encounterdata obtained from provider's patient databases.

A preferred HQM analysis engine 350 comprises one or more modulescapable of interacting with the agent interface or organizationinterface. Example modules include an analysis module 354 configured toaccess encounter data stored in a central or remote database 380, andconfigured to derive one or more measures. Another module can include areporting module 357 capable of generating a measure report from aderived measure where the report conforms to the reporting requirementsof an organization 320. Yet another module can include a data lockmodule 355 that allows the HQM service 350 to restrict access to data(e.g., encounter or non-encounter data) at a remote site to ensure thedata is stable before being downloaded, or uploaded. Still anotherpossible module includes a list processing module 358 used to processresult sets as part of a measure, or generated while deriving a measure.Still yet another module can include query module 356 that allows remoteparticipants to submit HQM queries to the engine 350, which can thengenerate lists (e.g., a result set) that satisfy the query.

In a preferred embodiment, an HQM analysis module 354 derives a measureby applying one or more measure selection criterion to encounter data,possibly stored locally or via an HQM agent at a provider site 310.Preferably, the selection criteria are used to generate one or morelists, each list having entries corresponding to encounters thatsatisfied the selection criteria. The lists can then be used to derive ameasure.

As discussed previously, a provider 310, or other member of thecommunity, can define a measure by creating an expression that can beevaluated. The expression comprises one or more elements of parameters,operators, or other selection criteria that can be used to select dataentries from the various databases. The results of applying theexpression is preferably a list of database entries from one or moredatabases representing encounters that satisfy the expression. The listscan then be used for further analysis to derive the measure. The measurecan be a simple, single value metric (e.g., ratio of a numerator todenominator), or a multi-valued data set comprising a metric and all thelists, or list entries, that went into forming the measure. In apreferred embodiment, the measure data is stored in the common HQMformat.

Once the various lists are generated, they can be processed via the listprocessing module 358. The list processing module can create new lists,merge lists, prune lists, filter lists, or otherwise support analysis ofthe data via list processing. It should be appreciated that lists areresult sets of filters placed on encounter data, where each entry in theencounter data can be considered an n-tuple. Such an approach providesfor quick, efficient analysis of provider performance measures, eitherautomated via the HQM service 350, or even manually by the provider 310or organization 320.

FIG. 4 illustrates a schematic of an embodiment where a healthorganization site 420 interfaces with the HQM service 450, assumingproper authentication, via an organization interface 460 represented byan organization HQM client 490. Healthcare data 430 can be exchangedover network 415. In a preferred embodiment the organization interface460 is configured to send measure requirements 462 or other HQMreporting information to the HQM service 450. Additionally, theorganization interface 460 is preferably configured to receive HQMreports 472, possibly in a serialized format. It is also contemplatedthat the organization interface 460 can include a data format normalizer470 (e.g., a translator) that can convert from a common HQM data formatto a proprietary format used by the organization to store measureinformation 480. It is even further contemplated that normalizer 470could convert from one proprietary format to another proprietary format.

FIG. 5 is a schematic of a method 500 for using the HQM client 290 andHQM Service 250 (see FIG. 2). First, a provider builds a measure usingmeasure builder 264. FIG. 6 shows an interface 600 for displaying ameasure expression. Interface 600 allows the health care provider tobuild and view a measure expression without the need for SQL queries(i.e., the expression does not need to be an SQL query or equivalentformat), thus obviating the need to learn a complex program language.Interface 600 includes drag-and-drop and point-and-click functionality.Second, the expression parts (see FIG. 6) are translated into SQLqueries and list are generated for each measure using HQM client 290.FIG. 7 shows an interface 700 for displaying the conversion of themeasure expressions into SQL queries. Third, the generated lists areconverted from infix notation into postfix notation (reverse polishnotation) and the lists are merged. FIG. 8 shows an interface 800 forconverting and displaying a measure expression as a postfix notationreverse polish algorithm. Finally, the merged lists are displayed innumerator and denominator counts and lists. FIG. 9 shows an interface900 for displaying patient counts and lists.

Method 500 allows providers to build measures and report measures tomany different health organizations, each using their own proprietaryformat, all without the need to know SQL programming. Method 500 alsoallows HQM client 290 and HWM service 250 to record mappings betweendifferent formats of provider-defined measures.

One should appreciate that the various elements or functionality of thedisclosed system can be moved from one location (e.g., provider, HQMengine, organization, etc.) to another without departing from the mainconcepts of the inventive subject matter. All arrangements offunctionality are contemplated. Furthermore, one should also appreciatethat the disclosed elements can be embodied by hardware or softwareinstallable at the various sites (e.g., the provider site, HQM servicesite, organization site, etc.)

Thus, specific compositions and methods of the inventive subject matterhave been disclosed. It should be apparent, however, to those skilled inthe art that many more modifications besides those already described arepossible without departing from the inventive concepts herein. Theinventive subject matter, therefore, is not to be restricted except inthe spirit of the disclosure. Moreover, in interpreting the disclosureall terms should be interpreted in the broadest possible mannerconsistent with the context. In particular the terms “comprises” and“comprising” should be interpreted as referring to the elements,components, or steps in a non-exclusive manner, indicating that thereferenced elements, components, or steps can be present, or utilized,or combined with other elements, components, or steps that are notexpressly referenced.

What is claimed is:
 1. A method of reporting health quality measures(HQMs) to a funding organization, the method comprising: providingaccess to an HQM client capable of converting patient data stored on ahealthcare provider's patient database from a proprietary format to acommon HQM data format; providing a healthcare organization interfacecoupled to the HQM client; receiving, by the HQM client, first patientdata in a first proprietary format from a first provider and secondpatient data in a second proprietary format from a second provider;generating, by the HQM client, first normalized patient data and secondnormalized patient data by normalizing the first and second patient datafrom their respective first and second proprietary formats to the commonHQM data format; defining an HQM expression for generating HQMs based ondifferent patient data types according to requirements set forth by thefunding organization; deriving, by the HQM client, a plurality of firstHQMs for the first provider and a plurality of second HQMs for thesecond provider according to the HQM expression and based on thedifferent patient data types, wherein the plurality of first HQMs arederived from the first normalized patient data and the plurality ofsecond HQMs are derived from the second normalized patient data;generating, by the HQM client, a presentation package comprising theplurality of first and second HQMs and the normalized first and secondpatient data; and presenting the package to the funding organization. 2.The method of claim 1, further comprising authenticating the fundingorganization with respect to the HQM client.
 3. The method of claim 1,wherein the HQM expression is defined by the first and second providers.4. The method of claim 3, wherein the step of defining the HQMexpression comprises allowing the first provider to drag and dropelements of selection criteria to form the HQM expression.
 5. The methodof claim 1, wherein the HQM expression is defined by the fundingorganization.
 6. The method of claim 1, wherein the step of deriving theplurality of first HQMs comprises calculating a numerator representing anumber of encounters in the first normalized patient data that satisfyselection criteria of a numerator portion of each of the first HQMs, andcalculating a denominator representing a number of encounters in thefirst normalized patient data that satisfy selection criteria of adenominator portion of the first HQMs.
 7. The method of claim 6, furthercomprising calculating each of the first HQMs as a ratio of thenumerator to the denominator.
 8. The method of claim 6, the step ofderiving the plurality of first HQMs further comprises generating aplurality of lists containing encounter data entries obtained from thefirst normalized patient data where each of the entries represents anencounter that satisfies individual selection criterion of the selectioncriteria from at least one of the numerator portion and the denominatorportion.
 9. The method of claim 8, wherein the plurality of first HQMsis derived based on at least some of the plurality of lists.
 10. Themethod of claim 6, wherein the denominator portion and the numeratorportion are expressed as a non-SQL query.
 11. The method of claim 6,further comprising the step of converting the denominator portion andthe numerator portion into an SQL query.
 12. The method of claim 6,further comprising the step of converting the denominator portion andthe numerator portion into a postfix notation reverse polish algorithm.13. The method of claim 1, wherein the step of defining the HQMexpression includes providing a point and click elements of selectioncriteria within the organization interface to form the HQM expression.14. The method of claim 1, wherein the step of generating thepresentation package includes automatically formatting the first andsecond HQMs according to the organization's requirements.